Euthanasia and physician-assisted suicide (PAS) by request and/or based on an advance directive are legal in The Netherlands under strict conditions, thus providing options for patients with Huntington's disease (HD) and other neurodegenerative diseases to stay in control and choose their end of life. HD is an inherited progressive disease characterised by chorea and hypokinesia, psychiatric symptoms and dementia. From a qualitative study based on interviews with 15 physicians experienced in treating HD, several ethical issues emerged. Consideration of these aspects (...) leads to a discussion about the professional role of a physician in relation to the personal autonomy of a patient. Such a discussion can raise awareness that talking about end-of-life wishes with an HD patient is part of the legal, professional and moral responsibility of the physician, and that a letter of intent on behalf of the physician can improve active participation in the process. Discussion of these issues can help to advance the debate on euthanasia and PAS in HD and other neurodegenerative diseases. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Conventional accounts of the development of the Enlightenment in the English-speaking world posit an evolution. Over time, it is argued, dominant ideas of the “divine attributes,” the characteristics of the First Person of the Trinity, moved from Calvinist images of God as a stern avenger to Latitudinarian reliance on God as an indulgent parent and Deist understandings of God as a First Cause, increasingly synonymous with Nature. This chapter argues that this view is mistaken. All the chief ways of conceiving (...) God had long been available; and powerful and sustained debates in the long eighteenth century about God’s nature followed no single direction. The classic model of the Enlightenment as the advance of secularization is untenable. (shrink)

Influential cases have been provided that seem to suggest that one can fail to have knowledge because of the social environment. If not a distinct kind of social defeater, is there a uniquely social phenomenon that defeats knowledge? My aim in this paper is to explore these questions. I shall argue that despite initial appearances to the contrary, we have no reason to accept a special class of social defeater, nor any essentially social defeat phenomenon. We can explain putative cases (...) of social defeat with our existing epistemological apparatus. (shrink)

The two center time dependent Dirac equation, for an electron in the external field of two colliding ultrarelativistic heavy ions is considered. In the ultrarelativistic limit, the ions are practically moving at the speed of light and the electromagnetic fields of the ions are confined to the light fronts by the extreme Lorentz contraction and by the choice of gauge, designed to remove the long-range Coulomb effects. An exact solution to the ultrarelativistic limit of the two-center Dirac equation is found (...) by using light-front variables and a light-fronts representation. Previously unexplained experimental results obtained at CERN's SPS are explained in this way and predictions are made as to where one should look, in momentum space, and in space-time, if one wants to study and observe non-perturbative electromagnetic pair-production effects in extremely relativistic heavy-ion collisions. (shrink)

Hume's doctrine of natural belief allows that certain beliefs are justifiably held by all men without regard to the quality of the evidence which may be produced in their favour. Examples are belief in an external world and belief in the veracity of our senses. According to R. J. Butler, Hume argues in the Dialogues that belief in God is of this sort. More recently John Hick has argued that for some people it is as natural to believe in God (...) as to believe in an external world. I shall first inquire what Hume understands by reasonable belief and by natural belief. I shall then use the results of this investigation to argue, against Butler, that belief in God is not a natural belief; and against Hick, more briefly, that his thesis is not viable in as far as it depends upon Hume's doctrine of natural belief. These discussions are important to the philosophy of religion since by means of natural beliefs it could be urged that belief in God is something justifiable without reference to reason or evidence: a position which would be of immense value to the theist. (shrink)

Short-circuit evaluation denotes the semantics of propositional connectives in which the second argument is evaluated only if the first argument does not suffice to determine the value of the expression. Free short-circuit logic is the equational logic in which compound statements are evaluated from left to right, while atomic evaluations are not memorised throughout the evaluation, i.e. evaluations of distinct occurrences of an atom in a compound statement may yield different truth values. We provide a simple semantics for free short-circuit (...) logic and an independent axiomatisation. Finally, we discuss evaluation strategies, some other SCLs, and side effects. (shrink)

The epistemic-basing relation is the relation that holds between a reason, or one’s grounds, and one’s belief when the belief is held for that reason. As I will explain, understanding this relation is crucial for epistemology since basing a belief on a reason seems necessary for epistemic justification to obtain. But what is the nature of this relation? Is it, at least in part, causal as one might assume? Or, due to problems with causal accounts, are rival accounts of the (...) basing relation motivated? That depends whether causal theories are really subject to the standard objections made against them. I will discuss what I take to be the most fundamental objection here. (shrink)

A case is made for supposing that the total probability accounted for in a decision analysis is less than unity. This is done by constructing a measure on the set of all codes for computable functions in such a way that the measure of every effectively accountable subset is bounded by a number <1. The consistency of these measures with the Savage axioms for rational preference is established. Implications for applied decision theory are outlined.

A reexamination of the Nobel-prize-winning experiment in which the antiproton was discovered reveals that the associated antimesons might be traveling faster than light. The time-of-flight experiment should be repeated with a view toward more accurate measurement of distance and time of flight to discredit or to confirm this tentative conclusion.

The influence of sediment oxygen heterogeneity, due to bioturbation, on diffusive oxygen flux was investigated. Laboratory experiments were carried out with 3 macrobenthic species presenting different bioturbation behaviour patterns: the polychaetes Nereis diversicolor and Nereis virens, both constructing ventilated galleries in the sediment column, and the gastropod Cyclope neritea, a burrowing species which does not build any structure. Oxygen two-dimensional distribution in sediments was quantified by means of the optical planar optode technique. Diffusive oxygen fluxes and a variability index were (...) calculated on the captured oxygen images. All species increased sediment oxygen heterogeneity compared to the controls without animals. This was particularly noticeable with the polychaetes because of the construction of more or less complex burrows. Integrated diffusive oxygen flux increased with oxygen heterogeneity due to the production of interface available for solute exchanges between overlying water and sediments. This work shows that sediment heterogeneity is an important feature of the control of oxygen exchanges at the sediment–water interface. (shrink)

The inverse of the distance between two structures $\mathscr{A} \not\equiv \mathscr{B}$ of finite type τ is naturally measured by the smallest integer q such that a sentence of quantifier rank q - 1 is satisfied by A but not by B. In this way the space $\operatorname{Str}^\tau$ of structures of type τ is equipped with a pseudometric. The induced topology coincides with the elementary topology of $\operatorname{Str}^\tau$ . Using the rudiments of the theory of uniform spaces, in this elementary note (...) we prove the convergence of every Cauchy net of structures, for any type τ. (shrink)

Most, perhaps all, states have “myths of origin”: those semi-historical, semi-propagandistic accounts of their founding and (what are termed) essential purposes. There is nothing unusual in the Uni...